Patient Right To Know Drug Prices Act
Americans overspend by an estimated $135 million on prescriptions through their insurance, in cases when they would cost less out of pocket. Yet pharmacists are often under gag orders from telling customers about that discrepancy.
A new bill introduced in the Senate [now signed into law] would end this practice.
A “pharmacy gag clause” is a tactic under which a pharmacist may not inform customers which of the two options would cost less for a certain product: using their health insurance or paying fully out of pocket.
These clauses are usually instituted by an insurer or pharmacy benefit manager (PBM), the most famous of which include CVS Health, Express Scripts, or United Health. They’re put in for cases in which most consumers would save money by paying out of pocket — if only they knew. Pharmacy benefit managers pocket the difference.
States are increasingly banning the practice, including three in March alone: Mississippi, South Dakota, and Virginia. The total is now 14 states, from red states like the ones mentioned above to blue states like Minnesota and Connecticut.
What the bill does
However, there is no such law on a federal level. The Know the Lowest Price Act would ban the practice of pharmacy gag clauses.
Introduced on March 14 by Sen. Susan Collins (R-ME), the bill is numbered S. 2554.
S. 2553: Know the Lowest Price Act of 2018
This bill prohibits a prescription drug plan under Medicare or Medicare Advantage from restricting a pharmacy from informing an enrollee of any difference between the price, copayment, or coinsurance of a drug under the plan and a lower price of the drug without health-insurance coverage. (Such restrictions are commonly referred to as gag clauses.)